Baseline musculoskeletal pain and impaired sleep related to school pressure influence the development of musculoskeletal pain in N = 107 adolescents in a 5-year longitudinal study.

PURPOSE: This longitudinal study followed 10- to 13-year-old adolescents for 5 years to investigate the effects of juvenile musculoskeletal (MSK) pain and psychosocial risk factors on future pain. We further predicted that increased MSK pain at follow-up would be positively related to current school pressure at follow-up and negatively related to current sleep quality. Sleep quality was tested as a potential mediator of the link between school pressure and MSK pain at follow-up after controlling for baseline MSK pain. METHODS: The baseline sample comprised 189 adolescents, and 5-year follow-up resulted in 107 15- to 18-year-old adolescents who had completed mandatory education. Adolescents responded to an online questionnaire about psychosocial stressors, MSK pain, school achievement and leisure activities. A longitudinal hierarchic linear regression including all significant baseline predictors was run to assess their impact on MSK pain 5 years later. Mediation analysis was used to investigate sleep quality as a potential mediator of the relationship between school pressure and MSK pain at follow-up. RESULTS: Baseline MSK pain predicted MSK pain over a time lag of 5 years (ß = .26, p = .02). The relationship between follow-up school pressure and current MSK pain was mediated by sleep quality at follow-up (B = .17, SEB = .07, 95% CI .06-.34) when baseline MSK pain was controlled. CONCLUSIONS: Juvenile MSK pain predicts MSK pain in adolescence. A psychosocial mediation model including school pressure and sleep impairments has the potential to explain MSK pain mechanisms in adolescents. These slides can be retrieved under Electronic Supplementary Material.

Comparison of pain-resilient working individuals to population-based case controls with/without momentary low back pain.

BACKGROUND: Few studies have examined the 20% of individuals who never experience an episode of low back pain (LBP). To date, no investigation has been undertaken that examines a group who claim to have never experienced LBP in their lifetime in comparison to two population-based case-control groups with and without momentary LBP. This study investigates whether LBP-resilient workers between 50 and 65 years had better general health, demonstrated more positive health behaviour and were better able to achieve routine activities compared with both case-control groups. METHODS: Forty-two LBP-resilient participants completed the same pain assessment questionnaire as a population-based LBP sample from a nationwide, large-scale cross-sectional survey in Switzerland. The LBP-resilient participants were pairwise compared to the propensity score-matched case controls by exploring differences in demographic and work characteristics, and by calculating odds ratios (ORs) and effect sizes. A discriminant analysis explored group differences, while the multiple logistic regression analysis specified single indicators which accounted for group differences. RESULTS: LBP-resilient participants were healthier than the case controls with momentary LBP and achieved routine activities more easily. Compared to controls without momentary LBP, LBP-resilient participants had a higher vitality, a lower workload, a healthier attitude towards health and behaved more healthily by drinking less alcohol. CONCLUSIONS: By demonstrating a difference between LBP-resilient participants and controls without momentary LBP, the question that arises is what additional knowledge can be attained. Three underlying traits seem to be relevant about LBP-resilient participants: personality, favourable work conditions and subjective attitudes/attributions towards health. These rationales have to be considered with respect to LBP prevention.

Resources for preventing sickness absence due to low back pain.

BACKGROUND: After an episode of non-specific low back pain (LBP) some individuals fail to return to work. The factors leading to such LBP-related sickness absence are not yet fully understood. AIMS: To identify individual resources, over and above the already established predictors, for preventing LBP-related sickness absence in a population-based sample of workers experiencing an episode of LBP. METHODS: Cohort study with 1-year follow-up. Participants were from a working population who reported an episode of acute or subacute LBP at baseline. Four potential resources-life satisfaction, doing sports, job satisfaction and social support at work-were examined for their incremental value in predicting sickness absence over and above baseline sickness absence and fear-avoidance beliefs about work. RESULTS: In all, 279 workers participated in the study. All four resources showed an inverse relationship with regard to sickness absence. A multiple regression analysis revealed that life satisfaction as a resource protected against sickness absence, when controlling for established risk factors. Job satisfaction and social support at work minimized the influence of sickness absence at baseline and at 1-year follow-up. CONCLUSIONS: In a non-clinical working sample of individuals experiencing an acute/subacute episode of LBP, life satisfaction was a unique predictor of sickness absence after 1 year. Prevention in the occupational setting should not only address common risk factors but also occupational and individual resources that keep workers satisfied with life despite having LBP.

[Efficacy, utility and cost-effectiveness of multidisciplinary treatment for chronic low back pain]. / Wirksamkeit, Zweckmässigkeit und Wirtschaftlichkeit des multimodalen Behandlungsansatzes bei chronisch lumbalen Rückenschmerzen.

BACKGROUND: Qualitative criteria, such as efficacy, utility and cost-effectiveness are essential for insurance and reimbursement companies to meet the costs for a multidisciplinary treatment (MDT) for persons with chronic low back pain (CLBP). METHOD: A systematic search concerning the qualitative criteria of MDT for CLBP presents an overview of the current literature. RESULTS: The search revealed 8 systematic reviews which document a moderate efficacy of MDT as a treatment for persons with CLBP although some reported restrictions. Analysis of 6 studies that have not yet been included in previous reviews confirmed the findings from these reviews. The comparison of conservative and surgical treatment for CLBP revealed that long-term outcomes hardly differed in quality, whereas surgical treatment was more expensive and contained more and higher risks. References on moderate to high cost-effectiveness of MDT are represented in 3 original studies. CONCLUSION: The MDT of CLBP is moderately efficient, purposeful, cost-effective and demonstrate an alternative treatment form to surgical treatment.

Identification of prognostic factors for chronicity in patients with low back pain: a review of screening instruments.

Low back pain (LBP) is currently the most prevalent and costly musculoskeletal problem in modern societies. Screening instruments for the identification of prognostic factors in LBP may help to identify patients with an unfavourable outcome. In this systematic review screening instruments published between 1970 and 2007 were identified by a literature search. Nine different instruments were analysed and their different items grouped into ten structures. Finally, the predictive effectiveness of these structures was examined for the dependent variables including "work status", "functional limitation", and "pain". The strongest predictors for "work status" were psychosocial and occupational structures, whereas for "functional limitation" and "pain" psychological structures were dominating. Psychological and occupational factors show a high reliability for the prognosis of patients with LBP. Screening instruments for the identification of prognostic factors in patients with LBP should include these factors as a minimum core set.

[Initial management of acute heart failure in the emergency department]. / Insuffisance cardiaque aiguë décompensée: prise en charge initiate aux urgences.

Acute decompensated heart failure is one of the most leading diseases among elderly patients presenting in the emergency department with a chief complaint of dyspnea. Initial management is crucial for the patient's outcome. In this article we propose a review of diagnosis, treatment, stratification and orientation of patients admitted to emergency department with acute heart failure in light of recent recommendations.